Common and distinctive approaches to motivation in different disciplines.

Over the last couple of decades, a body of theories has emerged that explains when and why people are motivated to act. Multiple disciplines have investigated the origins and consequences of motivated behavior, and have done so largely in parallel. Only recently have different disciplines, like psychology and economics, begun to consolidate their knowledge, attempting to integrate findings. The following chapter presents and discusses the most prominent approaches to motivation in the disciplines of biology, psychology, and economics. Particularly, we describe the specific role of incentives, both monetary and alternative, in various motivational theories. Though monetary incentives are pivotal in traditional economic theory, biological and psychological theories ascribe less significance to monetary incentives and suggest alternative drivers for motivation.

Applied economics: The use of monetary incentives to modulate behavior.

According to standard economic theory higher monetary incentives will lead to higher performance and higher effort independent of task, context, or individual. In many contexts this standard economic advice is implemented. Monetary incentives are, for example, used to enhance performance at workplace or to increase health-related behavior. However, the fundamental positive impact of monetary incentives has been questioned by psychologists as well as behavioral economists during the last decade, arguing that monetary incentives can sometimes even backfire. In this chapter, studies from proponents as well as opponents of monetary incentives will be presented. Specifically, the impact of monetary incentives on performance, prosocial, and health behavior will be discussed. Furthermore, variables determining whether incentives have a positive or negative impact will be identified.

Well-being in patients with amyotrophic lateral sclerosis and their next of kin over time.

OBJECTIVES: The well-being and physical function among patients with ALS and their next of kin was studied over time. MATERIALS AND METHODS: Thirty-five patients with ALS and their next of kin were studied with respect to physical, general and psychological well-being by the visual analogue scale (VAS) every 4-6 months. Physical function in patients was rated by the ALSFRS-R and the Norris scale. Patients and next of kin rated the well-being of themselves and their counterpart. RESULTS: The well-being was stable and there was a relation between the well-being of patients and next of kin throughout the time studied. Next of kin rated the well-being of the patients worse than patients rated themselves, while patients rated the well-being of their next of kin at the same level as their counterpart. CONCLUSIONS: The basic state of well-being as well as the interaction between patient and next of kin seem to be factors that influence the well-being of both patients and their next of kin.

Spiritual thoughts, coping and 'sense of coherence' in brain tumour patients and their spouses.

When a person is diagnosed with a life-threatening disease, existential questions are easily triggered. The aims of this study were to explore to what extent brain tumour patients and their next of kin were able to cope, understand and create meaning in their situation, to explore whether spirituality could be supportive and to analyse whether these concepts are related to Antonovsky's concept of sense of coherence. Using a purposive sampling technique, 20 patients and 16 of their next of kin took part in tape-recorded interviews. A content and context analysis was performed using a hermeneutic approach. We found that comprehensibility was to a large extent constructed by the patient's own thoughts and theories, despite an insecure situation. Manageability was achieved by active information-seeking strategies, by social support and by coping, including positive reinterpretation of the situation. Meaningfulness was central for quality of life and was created by close relations and faith, as well as by work. A crucial factor was whether the person had a 'fighting spirit' that motivated him or her to go on. As only three patients were believers, trust in God had generally been replaced by a belief and confidence in oneself, in science, in positive thinking and by closeness to nature. Sense of coherence as a concept can explain how exposed persons handle their situation. In its construction, sence of coherence integrates essential parts of the stress/coping model (comprehensibility, manageability) and of spirituality (meaning).

Existential support in brain tumour patients and their spouses.

UNLABELLED: Caring for patients with brain tumours raises existential questions. The aims of this study were to describe the opinions of nurses, patients and next-of-kin on existential support and how this is prioritised. PATIENTS AND METHOD: a total of 20 brain tumour patients, 16 family members and 16 nurses underwent explorative, tape-recorded, semi-structured interviews about existential issues. RESULTS: the nurses' opinions about the importance and prioritisation of existential support could be divided into four main groups: 1) religion, 2) "a diffuse picture", 3) conversation, and 4) questions of vital importance. They generally had a favourable attitude towards existential issues but thought those issues were difficult to deal with in practice due to lack of time, lack of knowledge and fear. Without exception, patients and family members were satisfied with the medical and physical treatment, but not with the existential support. They had, to a great extent, wished for existential support, and especially for the opportunity of talking about the existential threat that had arisen. Obstacles to this were thought to be due to the staff being under much stress, being afraid and unskilled. The importance of closeness and presence, which decreased existential isolation, was emphasised.

Human isophane or lente insulin? A double blind crossover trial in insulin dependent diabetes mellitus.

Fifty two children with insulin dependent diabetes mellitus were randomised to receive human isophane or lente insulin preparations in combination with soluble insulin in a double blind trial. Patients were seen every two months, and crossed over after four months of treatment. Control assessed by glycated haemoglobin was significantly lower in children on human isophane insulin, but fasting blood glucose and fructosamine concentrations and the number of episodes of hypoglycaemia were similar on both regimens. In five children on twice daily insulin regimens, insulin profiles throughout a 24 hour period demonstrated greater variability on lente compared with isophane insulin despite identically administered insulin doses. A questionnaire completed at the end of the study showed that two thirds of the children and/or their parents preferred the isophane insulin, and they gave perceived improvement of metabolic control as the major reason for their choice.

Factors underlying suicidal ideation among college students: a test of Teicher and Jacobs' model.

The study examined three factors thought to be involved in the etiology of suicidal ideation in adolescents: an absence or disruption of interpersonal attachments, a conviction of personal helplessness, and a sense of hopelessness regarding the future. Subjects, 191 college students age 21 or less, completed questionnaires assessing suicidal ideation, parent and peer attachments, locus of control, and hopelessness. Nearly 61 per cent of the subjects reported at least some degree of suicidal ideation, and 21 per cent reported moderate or high levels of ideation. Both low-level and moderate- to high-level ideators reported poorer relationships with their parents than non-ideators. In addition, compared to non-ideator and low-ideator subjects, moderate to high ideators reported poorer relationships with peers and greater convictions of helplessness and hopelessness about the future. No gender differences were found other than a suggestion that insecure attachment to parents may be a more important factor in the genesis of suicidal ideation in college women than men.

Different operating conditions affect risk of hepatitis B virus infection at two residential institutions for the mentally disabled.

The prevalence of hepatitis B virus markers was determined in two residential institutions for the mentally disabled which exhibited major differences in operating policies. Eighty per cent of 91 clients and 16% of 92 employees at institution A had positive tests for hepatitis B virus markers, including two staff members and one client with serologic evidence of recent infection (immunoglobulin M antibody to hepatitis B core antigen). In contrast, 34% of 395 clients and 8% of 294 workers at institution B were positive for hepatitis B virus markers, and none of the staff demonstrated evidence of recent infection. The observed differences in seroprevalence were likely to have been influenced by substantial disparities in living conditions, staff-to-client ratios in critical areas, and level of employee experience. In addition to significant institutional differences, seroprevalence was associated with severity of mental retardation in clients and duration of employment in staff. This study emphasizes the importance of local policies in the prevention of hepatitis B virus infection at residential institutions for the mentally disabled.

Cyclocryotherapy in the treatment of advanced glaucoma.

Cyclocryotherapy in the treatment of aphakic open-angle glaucoma (AO), aphakic angle-closure glaucoma (ACL), and neovascular glaucoma (NVG) was evaluated in 96 eyes of 96 patients. All patients had follow-up of greater than 12 months, with a mean of 29.0 +/- 2.1 months (+/- SEM). Intraocular pressure (IOP) was lowered to less than 21 mmHg in 76% of eyes with AO, 68% of eyes with ACL, and 55% of eyes with NVG. Patients with NVG lost vision more frequently (70%) than patients with AO (41%) or ACL (41%). Patients with NVG had a higher incidence of loss of light perception and phthisis bulbi than patients with ACL (P less than 0.015). In patients having visual field examinations (76/96), glaucomatous field loss was arrested in 71% of patients with AO and 65% of patients with ACL, compared to 29% of patients with NVG (P less than 0.025). There was a significant correlation between postoperative IOP less than 21 mmHg and preservation of visual field. Patients receiving initial 360 degrees cryosurgical treatment required fewer repeat treatments than patients receiving initial 180 degrees treatment (P = 0.004); complications were slightly more common in the 360 degrees group.

Immune globulin and hepatitis B immune globulin. Prophylactic measures for intimate contacts exposed to acute type B hepatitis.

We studied the relative prophylactic efficacies of recently derived immune globulin containing antibody to hepatitis B surface antigen (anti-HBs) and hepatitis B immune globulin in 60 intimate contacts exposed to acute type B hepatitis. Forty susceptible contacts were randomly assigned to treatment with either a single intramuscular dose of immune globulin or hepatitis B immune globulin (0.06 mL/kg of body weight), following which observation was maintained over a 12-month period. Twenty additional contacts received the equivalent of twice the dose of immune globulin given to the first group, and follow-up was maintained for six months. Neither the hepatitis B virus (HBV) attack rates (11% to 19%) nor the frequency of clinical illness (0% to 4.8%) was substantially different in the three groups. When compared with average frequencies reported in the literature, significantly lower illness rates were noted for immune globulin recipients. These data indicate that currently derived immune globulin as well as hepatitis B immune globulin may confer protection from illness (le, passive-active immunity) in the setting of intimate exposure to HBV.

Prevaccination screening of medical and dental students. Should low levels of antibody to hepatitis B surface antigen preclude vaccination?

The prevalence of hepatitis B virus (HBV) markers in 484 medical and 329 dental students was studied. Three students (0.9%) were hepatitis B surface antigen (HBsAg) reactive, and 46 students (5.7%) were reactive for antibody to HBsAg (anti-HBs). There was no difference in anti-HBs frequency between medical and dental students, and the prevalence of this marker was not associated with year in school. Of the 46 reactors, eight (17%) were nonreproducible and 38 (83%) were reproducibly reactive when the same samples were reanalyzed. Of note, all nonreproducible reactors exhibited anti-HBs sample-negative control (S/N) ratios of less than 10, and none were positive for antibody to hepatitis B core antigen (anti-HBc). Nineteen (50%) of the reproducible reactors had anti-HBs S/N ratios equal to or greater than 10, and only 15 (39%) were anti-HBc positive. In view of these observations, we do not recommend HBV screening in a vaccine program for health students. Due to the frequency with which low-level anti-HBs reactors without anti-HBc are found to be nonreproducibly positive, we are concerned by the potential overinterpretation of such results before the formulation of decisions about the need for vaccination.